PURPOSE: Research on effectiveness of low-threshold mobility interventions that are viable for users of residential aged care is scarce. Low-threshold is defined as keeping demands on organizations (staff skills, costs) and participants (health status, discipline) rather low. The study explored the effectiveness of a multi-faceted, low-threshold physical activity program in three residential aged-care facilities in Austria. Main goals were enhancement of mobility by conducting a multi-faceted training program to foster occupational performance and thus improve different aspects of health-related quality of life (QoL).
PARTICIPANTS AND METHODS: The program consisted of a weekly session of 60 minutes over a period of 20 weeks. A standardized assessment of mobility status and health-related QoL was applied before and after the intervention. A total of 222 of 276 participants completed the randomized controlled trial study (intervention group n=104, control group n=118; average age 84 years, 88% female).
RESULTS: Subjective health status (EuroQoL-5 dimensions: P=0.001, d=0.36) improved significantly in the intervention group, and there were also positive trends in occupational performance (Canadian Occupational Performance Measure). No clear effects were found concerning the functional and cognitive measures applied.
CONCLUSION: Thus, the low-threshold approach turned out to be effective primarily on subjective health-related QoL. This outcome could be a useful asset for organizations offering low-threshold physical activity interventions.

The use of group discussions: a case study of learning about organisational characteristics of schools. DOI: 10.1080/13645579.2013.860746. International Journal of Social Research Methodology, 18 (2), 127-143.

This paper focuses on the use of group discussions (GD), as a very open and flexible method of data generation, to learn about organisational characteristics of schools. In comparison to the more structured focus group method, the method of GD is less known; however, we demonstrate that it is a useful method to learn about how specific groups are constituted. The paper will draw on the findings and experiences of nine GDs that were organised with teachers, students and parents in three schools in Austria. They were conducted as part of a case study to learn about the influence of schools’ organisational characteristics on the implementation of health promotion interventions. GDs were analysed using hermeneutic system analysis. We will present our findings, discuss benefits and limitations of using GDs, and give recommendations for the future use within school (or organisational) research.

Gugglberger,L., Hall,C. (2015):

Is there a need for a European doctorate in health promotion and public health? health education journal, 74 (2), 209-220.

OBJECTIVES: This paper summarises the context and rationale behind developing a European doctorate in health promotion and public health and its relevance to the international context. Since no Pan-European doctorate exists to date, a network of universities and higher education institutions across Europe has been working towards the establishment of a European doctorate in health promotion and public health. This paper describes the consensus-building process among this network of core stakeholders, combining key learning outcomes with the results of a scoping study. We critically examine some of the challenges encountered and discuss the potential need for such a doctoral level qualification.
METHODS: The consensus-building process included several meetings as well as a qualitative scoping study, consisting of nine qualitative interviews with and two written responses from different stakeholders in the area of doctoral education.
RESULTS: We describe the different requirements, benefits and challenges linked to the development of a European doctorate in health promotion and public health that were identified within the consensus-building process and in the qualitative data.
CONCLUSION: Overall, the benefits identified suggest that a European doctorate in health promotion and public health would be a positive and progressive initiative. However, the potential added value and the demand for such a doctorate still need to be examined.

BACKGROUND: Pressure within school can be a critical component in understanding how the school experience influences young people’s intellectual development, physical and mental health and future educational decisions. METHODS: Data from five survey rounds (1993/1994, 1997/1998, 2001/2002, 2005/2006 and 2009/2010) were used to examine time-, age- and gender-related trends in the amounts of reported school pressure among 11-, 13- and 15-year-olds, in five different regions (North America, Great Britain, Eastern Europe, Nordic and Germanic countries). RESULTS: Across the regions the reported perceptions of school pressure did not change between 1994 and 2010, despite a temporary increase in 2002 and 2006. With the exception of children at 11 years of age, girls reported higher levels of school pressure than boys (Cohen’s d from 0.12 to 0.58) and school pressure was higher in older age groups. These findings were consistent across countries. Regionally, children in North America reported the highest levels of school pressure, and students in the Germanic countries the lowest. CONCLUSION: Factors associated with child development and differences in societal expectations and structures, along with the possible, albeit, differential impact of the Programme for International Student Assessment (PISA), may partially explain the differences and trends found in school pressure. School pressure increases alongside the onset of adolescence and the shift from elementary school to the higher demanding expectations of secondary education. Time-related increases in school pressure occurred in the years following the release of the PISA results, and were larger in those regions in which results were less positive.

School climate measurement is a long-standing topic in educational research. This review article provides an overview and appraisal of school climate measures published between 2003 and 2013 in scientific journals. A search for published school climate instruments for secondary school students was made in three databases. Twelve articles meeting the inclusion criteria were identified and included. Each measure is described in terms of contents, and psychometric and formal quality criteria. Most of the reviewed measures showed good or acceptable results in reliability analyses but insufficient validity testing. Theory-grounding for measurement development is often missing. All instruments include items addressing the relationship among students and between students and teachers while the environmental-structural area is considered the least. This review provides a compact overview of recently published studies using school climate instruments that have also been tested psychometrically. This may be useful for schools, practitioners, and researchers.

BACKGROUND: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations.
METHODS: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews.
RESULTS: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model.
DISCUSSION: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.

BACKGROUND: Implementation is critical to the success of health promotion (HP) in schools, but little is known about how schools can best be assisted during this process. This article focuses on Austrian HP providers and aspects their roles incorporate.
OBJECTIVE: To investigate the providers' role in the practice of HP implementation and how it differs from its official description. On the basis of these findings, implications are suggested.
METHODS: The data were gathered within the framework of an explorative case study of complex HP interventions. We draw on four interviews with HP organisation staff, five documents from the providers' organisations and seven interviews with school staff from three schools.
RESULTS: In practice, providers took up different responsibilities, e.g., acting as emotional support to school staff and supporting the documentation of projects, guided more by the schools' needs than by the programmes they are helping to implement. Providers focused mostly on the implementation of single activities and did little to emphasize the necessity of organisational change.
POLICY IMPLICATIONS: Our findings suggest that providers' background in health should be complemented by a deeper understanding of the importance of organisational change to further support HP implementation.

Health promotion, as one tool of hospital managers to reorient hospitals towards more client-oriented healthcare services, has been emphasized for almost three decades. Yet, it is recognized that change in hospitals is challenging and is more desired than substantially enacted. To overcome organizational challenges, health promotion has, so far, adapted organizational change strategies primarily applied in business organizations. However, in this paper, it is argued that such strategies do not adequately reflect the nature of hospitals as ‘professional organizations’. To gain a better understanding of the challenges for health promotion reorientation, this paper combines well-established theories from the sociology of professions and organizational science. These theories provide a useful framework that advances the role of professionals as powerful agents within any reorientation efforts in hospitals. This framework guided the narrative review of empirical literature on critical dimensions along which professionals engage with reorientation efforts in hospitals. Accordingly, specific managerial strategies to facilitate health promotion reorientation are formulated. With its theoretical underpinnings and related empirical studies, the paper offers a new perspective on the challenges of implementing health promotion and proposes strategies that may help hospital managers to push forward health promotion reorientation in their organizations.

BACKGROUND: The Baby-Friendly Hospital Initiative (BFHI) aims to promote and support breastfeeding. Globally, around 20,000 facilities have been designated Baby-Friendly. In Austria, however, only 16% of the maternity units have received BFHI-certification. Internationally, few studies have investigated facilitating or hindering factors for BFHI implementation. The need to extend BFHI-certification rates has been investigated previously, but little is known about why maternity units decide to become BFHI-certified, how BFHI is installed at the unit level, and which factors facilitate or impede the operation of the BFHI in Austria and how barriers are overcome.
METHODS: Using a qualitative approach, (health) professionals’ perceptions of the selection, installation, as well as facilitators of and barriers to the BFHI were investigated. 36 semi-structured interviews with persons responsible for BFHI implementation (midwives, nurses, physicians, quality manager) were conducted in three Austrian maternity units. Data were analyzed using thematic analysis.
RESULTS: Interviewees mentioned several motives for selecting the BFHI, including BFHI as a marketing tool, improvement of existing services, as well as collaboration between different professional groups. In each hospital, “change agents” were identified, who promoted the BFHI, teamed up with the managers of other professional groups and finally, with the manager of the unit. Installation of BFHI involved the adoption of project management, development and dissemination of new standards, and training of all staff. Although multiple activities were planned to prepare for actually putting the BFHI into practice, participants mentioned not only facilitating, but also several hindering factors. Interpretations of what facilitated or impeded the operation of BFHI differed among and between professional groups.
CONCLUSION: Successful implementation of the BFHI in Austria depends on a complex interplay of multiple factors including a consensual “bottom-up” selection process, followed by a multifaceted installation stage. Even these activities may be perceived as a hindrance for non-BFHI-certified hospitals. Findings also suggest that despite active preparation, several barriers have to be overcome when BFHI is actually incorporated into routine practices. BFHI seems to pose a great challenge to health professionals’ work routines and, thus, clear structural changes of such routines as well as ongoing monitoring and support activities are required.

Prevalence of eating disorder risk and associations with health-related quality of life: Results from a large school-based population screening using the SCOFF questionnaire. Accepted for publication in: European Eating Disorders Review.

OBJECTIVE: The objective of this study was to investigate the prevalence of eating disorder (ED) risk as well as associated psychopathology and health-related quality of life (HrQoL) in a large population sample of Austrian adolescents.
METHOD: A sample of 3610 adolescents aged 10–18 years was recruited from 261 schools representative for the Austrian population. The SCOFF questionnaire was used to identify participants at risk for EDs, and the Youth Self-Report and KIDSCREEN were used to assess general psychopathology and HrQoL.
RESULTS: In total, 30.9% of girls and 14.6% of boys were screened at risk for EDs. SCOFF scores were significantly associated with internalising and externalising behavioural problems as well as HrQoL after controlling for sex, age and body mass index. The SCOFF score further turned out to be an independent predictor of HrQoL.
DISCUSSION: The high prevalence of ED risk among Austrian adolescents points out the need for prevention in this field. Variables indicating eating pathology should be included in general mental health screenings.